My friend Laura and I recently contemplated the mental strain that combatants, civilians and non-combatants — such as medics — face. Battlefield medicine is a remarkable success story; however, frontline soldiers and civilians are subject to increasingly deadly weapons. More survive to reach combat hospitals, but they suffer a more complex degree of morbidity.

These hospitals deal with brutally battered patients arriving daily. Many of the wounded are innocent civilians whose neighborhoods have become battlefields. Improvised explosive devices are cheaply produced and send shrapnel and intense heat at 1,600 feet per second. The horrendous results include traumatic amputations, burns and vascular/neurologic/ brain/orthopedic wounds.

Designed to destroy military vehicles, one can imagine the effect on unprotected civilians. Looking back to a 2007 spring night, casualties were typically vast in our field hospital, but I will never forget two patients: a little Iraqi girl and an American soldier. Nora had been a happy, sweet child of 9 and now was utterly bewildered. She was disoriented by the blast and the loss of family, and I saw her eyes pleading to make some sense of the slaughter around her. The floor of the ER was littered with bits of clothing cut from the wounded, blood, disused tourniquets, boots containing feet and legs. I talked with Nora, holding her trembling hand, stained with her mother’s blood. Her hearing dimmed by the blast and her face smudged with bomb residue and tears; she could say little. Her father and two brothers were killed in the attack that targeted U.S. soldiers in Baqubah. Nora’s mother was severely wounded by the blast and wouldn’t survive the night. Many soldiers were also killed and wounded that night. The soldier foremost in my mind was recruiting poster perfect. But this night, both his arms were amputated by the same blast that tore through Nora’s life. He was alert and acutely aware of his condition. We knew this from his desperate pleas for us to let him die. The mental strain? Trauma is any event that induces intense fear, helplessness or horror that is unbearable and intolerable. It affects the entire human organism.

Post-traumatic stress disorder occurs when the body, mind and brain continue to defend against a threat that belongs in the past, and the deregulation induced by that trauma becomes the body’s default state. PTSD is the “biological aftershocks” of trauma. The severity of combat exposure is the most important factor in determining whether a soldier would develop symptoms of PTSD, along with an early life scarred by adversity, and having witnessed or participated in harming civilians or prisoners. Nora would be 19 now — if alive. One wonders what legacy she will pass on to the next generation. Will her voice fuel Islamist jihad or that of reconciliation?

Regardless, the U.S. has much to atone for in this region before true healing can start. On this Veteran’s Day, as President Donald Trump contemplates capricious endeavors across the globe and the Pentagon calculates hubristic options that discount the value of foreign lives, I want them to reflect on Nora and the soldier and what their lives might have been, to consider Voltaire’s observation that “It is forbidden to kill; therefore all murderers are punished unless they kill in large numbers and to the sound of trumpets.”

Perhaps if we nurture empathy for these victims of war — and for all human suffering — we would more cautiously contemplate our military exploits.

About the authors: Laura Franseen, of Suttons Bay, Mi, is a practicing psychiatrist and a member of Veterans For Peace. Dave Lannen, of Traverse City, Mi, is a retired U.S. Air Force colonel and a member of Veterans For Peace.

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